Referral Form

3Dental · Mobile Dental Imaging

CBCT · Panoramic · Cephalometric · Intraoral Scan · Clinical Photography

Patient Information

Referring Dentist/Clinic Information

Requested Examinations

Region of Interest (CBCT)

Indicate teeth or area of interest for measurement

Notes / Objective of Examination

  • Radiation exposure is minimal and within dental safety standards.
  • Please bring ID to the appointment.
  • Pregnant patients must inform the staff before imaging.
Download referral-form.pdf